Similarly, American Public Media reported on the COVID-19 mortality rate by race/ethnicity through July

21, 2020, including Washington, DC, and 45 states (see figure 1). These data, while showing an alarming
death rate for all races, demonstrate how minorities are hit harder and how, among minority groups,
the African American population in many states bears the brunt of the pandemic’s health impact.

Approximately 97.9 out of every 100,000 African Americans have died from COVID-19, a mortality rate
that is a third higher than that for Latinos (64.7 per 100,000), and more than double than that for whites
(46.6 per 100,000) and Asians (40.4 per 100,000). The overrepresentation of African Americans among
confirmed COVID-19 cases and number of deaths underscores the fact that the coronavirus pandemic,
far from being an equalizer, is amplifying or even worsening existing social inequalities tied to race,
class, and access to the health care system.

Considering how African Americans and other minorities are overrepresented among those getting
infected and dying from COVID-19, experts recommend that more testing be done in minority
communities and that more medical services be provided.[12] Although the law requires insurers to
cover testing for patients who go to their doctor’s office or who visit urgent care or emergency rooms,
patients are fearful of ending up with a bill if their visit does not result in a COVID test. Furthermore,
minority patients who lack insurance or are underinsured are less likely to be tested for COVID-19, even
when experiencing alarming symptoms. These inequitable outcomes suggest the importance of
increasing the number of testing centers and contact tracing in communities where African Americans
and other minorities reside; providing testing beyond symptomatic individuals; ensuring that high-risk
communities receive more health care workers; strengthening social provision programs to address the
immediate needs of this population (such as food security, housing, and access to medicines); and
providing financial protection for currently uninsured workers.

Social determinants of health and the pandemic’s impact on African Americans’ health outcomes

In international human rights law, the right to health is a claim to a set of social arrangements—norms,
institutions, laws, and enabling environment—that can best secure the enjoyment of this right. The
International Covenant on Economic, Social and Cultural Rights sets out the core provision relating to
the right to health under international law (article 12).[13] The United Nations Committee on Economic,
Social and Cultural Rights is the body responsible for interpreting the covenant.[14] In 2000, the
committee adopted a general comment on the right to health recognizing that the right to health is
closely related to and dependent on the realization of other human rights.[15] In addition, this general
comment interprets the right to health as an inclusive right extending not only to timely and appropriate
health care but also to the determinants of health.[16] I will reflect on four determinants of health—
racism and discrimination, poverty, residential segregation, and underlying medical conditions—that
have a significant impact on the health outcomes of African Americans.

Racism and discrimination

In spite of growing interest in understanding the association between the social determinants of health
and health outcomes, for a long time many academics, policy makers, elected officials, and others were
reluctant to identify racism as one of the root causes of racial health inequities.[17] To date, many of the
studies conducted to investigate the effect of racism on health have focused mainly on interpersonal
racial and ethnic discrimination, with comparatively less emphasis on investigating the health outcomes
of structural racism.[18] The latter involves interconnected institutions whose linkages are historically
rooted and culturally reinforced.[19] In the context of the COVID-19 pandemic, acts of discrimination are
taking place in a variety of contexts (for example, social, political, and historical). In some ways, the
pandemic has exposed existing racism and discrimination.

Poverty (low-wage jobs, insurance coverage, homelessness, and jails and prisons)

Data drawn from the 2018 Current Population Survey to assess the characteristics of low-income
families by race and ethnicity shows that of the 7.5 million low-income families with children in the
United States, 20.8% were black or African American (while their percentage of the population in 2018
was only 13.4%).[20] Low-income racial and ethnic minorities tend to live in densely populated areas
and multigenerational households. These living conditions make it difficult for low-income families to
take necessary precautions for their safety and the safety of their loved ones on a regular basis.[21] This
fact becomes even more crucial during a pandemic.

Low-wage jobs: The types of work where people in some racial and ethnic groups are overrepresented
can also contribute to their risk of getting sick with COVID-19. Nearly 40% of African American workers,
more than seven million, are low-wage workers and have jobs that deny them even a single paid sick
day. Workers without paid sick leave might be more likely to continue to work even when they are sick.
[22] This can increase workers’ exposure to other workers who may be infected with the COVID-19 virus.

Similarly, the Centers for Disease Control has noted that many African Americans who hold low-wage
but essential jobs (such as food service, public transit, and health care) are required to continue to
interact with the public, despite outbreaks in their communities, which exposes them to higher risks of
COVID-19 infection. According to the Centers for Disease Control, nearly a quarter of employed Hispanic
and black or African American workers are employed in service industry jobs, compared to 16% of non-
Hispanic whites. Blacks or African Americans make up 12% of all employed workers but account for 30%
of licensed practical and licensed vocational nurses, who face significant exposure to the coronavirus.
[23]